P55. What is the value of undergoing surgery for spinal metastases at dedicated cancer centers?

Abstract

BACKGROUND CONTEXT The Alliance of Dedicated Cancer Centers is an organization of 11 leading cancer institutions/affiliated hospitals that are exempt from the Medicare prospective system (PPS) hospital reimbursement policies. Because of their focus on cancer care, as well as participation in innovative cancer treatment methods/protocols, these hospitals are largely reimbursed based on their actual billings. Due to the lack of incentive to meet a pre-determined target price and/or reduce costs, recent critics have often questioned the value of cancer care at these institutions. PURPOSE The current study aims to evaluate differences in 90-day outcomes for patients undergoing surgical treatment (decompression or fusion) for spinal metastases at dedicated cancer centers (DCC) versus other non-DCC hospitals. STUDY DESIGN/SETTING Retrospective review of the 100% Medicare Standard Analytical Files (SAF100). PATIENT SAMPLE The 2005-2014 100% Medicare Standard Analytical Files (SAF100) was queried using International Classification of Diseases 9th Edition (ICD-9) procedure and diagnosis codes to identify patients undergoing decompression or fusion for spinal metastases. Medicare hospital provider IDs/CCNs were used to identify the 11 DCC hospitals. OUTCOME MEASURES Ninety-day complications, readmissions, mortality and costs. METHODS Multi-variate logistic regression analyses were used to compare rates of 90-day complications and 90-day mortality between DCC and Non-DCC hospitals, while controlling for baseline clinical characteristics, procedural factors and hospital-level factors. Generalized linear regression modeling was used to evaluate differences in total 90-day costs between DCC and Non-DCCs. RESULTS A total of 17,776 patients were included – out of which 1,138 (6.4%) underwent management at one of the 11 DCC hospitals. DCCs were more likely to treat patients with spinal metastases due to renal cancers, slightly higher comorbidity burden and those with a median household income below the national quintile. DCCs were also more likely to treat patients with either fusion or decompression and fusion, as compared to decompression alone. DCCs also were more likely to do longer fusions, and treat patients with postoperative radiation and chemotherapy. After adjusting for differences in baseline clinical characteristics, procedural factors and hospital-level factors, patients undergoing surgery at DCC (vs a non-DCC) had a significantly lower risk of experiencing sepsis (6.5% vs 9.9%; OR 0.55, p CONCLUSIONS Based on our findings, it appears that DCCs offer high-value care, as evidenced by lower complication rates and reduced costs, following surgery for spinal metastases. Further study is required to better understand the processes of care adopted at these institutions, so that additional cancer centers may also be able to deliver high-value care. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.